Background: In Japan, the revision of the fee schedules in 2006 introduced a new category of general care ward\nfor more advanced care, with a higher staffing standard, a patient-to-nurse ratio of 7:1. Previous studies have\nsuggested that these changes worsened inequalities in the geographic distribution of nurses, but there have been\nfew quantitative studies evaluating this effect. This study aimed to investigate the association between the\ndistribution of 7:1 beds and the geographic distribution of hospital nursing staffs.\nMethods: We conducted a secondary data analysis of hospital reimbursement reports in 2012 in Japan. The study\nunits were secondary medical areas (SMAs) in Japan, which are roughly comparable to hospital service areas in the\nUnited States. The outcome variable was the nurse density per 100,000 population in each SMA. The 7:1 bed\ndensity per 100,000 population was the main independent variable. To investigate the association between the\nnurse density and 7:1 bed density, adjusting for other variables, we applied a multiple linear regression model, with\nnurse density as an outcome variable, and the bed densities by functional category of inpatient ward as\nindependent variables, adding other variables related to socio-economic status and nurse workforce. To investigate\nwhether 7:1 bed density made the largest contribution to the nurse density, compared to other bed densities, we\nestimated the standardized regression coefficients.\nResults: There were 344 SMAs in the study period, of which 343 were used because of data availability. There were\napproximately 553,600 full time equivalent nurses working in inpatient wards in hospitals. The mean (standard\ndeviation) of the full time equivalent nurse density was 426.4 (147.5) and for 7:1 bed density, the figures were 271.9\n(185.9). The 7:1 bed density ranged from 0.0 to 1,295.5. After adjusting for the possible confounders, there were\nmore hospital nurses in the areas with higher densities of 7:1 beds (standardized regression coefficient 0.62, 95%\nconfidence interval 0.56ââ?¬â??0.68).\nConclusion: We found that the 7:1 nurse staffing standard made the largest contribution to the geographic\ndistribution of hospital nurses, adjusted for socio-economic status and nurse workforce-related factors.
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